Surgery for Portal Hypertension (Ascites, Esophageal Varices)
Portal hypertension is a condition in which pressure inside the portal vein is higher than normal. The portal vein is a blood vessel that carries blood from the stomach and intestines to the liver. It is the only vein in the human body that brings blood to an organ instead of taking the blood away from an organ.
Unobstructed portal vein flow is essential for normal liver function. When the pressure in the portal vein is increased due to an obstruction before the vein reaches the liver, cirrhosis of the liver or obstruction of the flow of blood from the liver can occur. Because of the increased pressure in the portal system, the blood seeks alternative ways of reaching the heart. The body usually responds with mechanisms to reroute the blood, such as increasing the size of the spleen, enlarging the veins in the stomach and esophagus, and dumping excess fluid into the abdominal cavity. The result is large amounts of fluid in the abdomen (ascites) and esophageal and gastric varices (large veins in the throat and stomach). People with varices have a strong risk of gastrointestinal bleeding. Ascites causes discomfort, difficulty breathing, and ultimately muscle deterioration and death if left untreated.
Best doctor in his class.. No words can describe the brains this man has! He has saved my mothers life not once but twice. Doctor Alden has done what other doctors said could not be done and gave my mom a extended lease in life. You are a true blessing to have as a doctor! Thank you and to the entire team of Doctors at lenox hill. We trust you with our moms life. ~ Vitals
Various procedures have been developed to treat portal hypertension. The number one treatment of choice for portal hypertension today is TIPS surgery (transjugular intrahepatic portosystemic shunt). TIPS surgery is performed in a radiology department. It is a minimally invasive procedure that has low risk and excellent outcomes. Dr. Dmitri Alden’s interventional radiology team performs this procedure routinely.
Unfortunately, not all patients are candidates for TIPS. In some patients, only surgical correction of portal hypertension is possible. Various shunting procedures have been developed over time. These shunting procedures should be performed only by hepatobiliary surgeons with prior transplantation experience.
The particular shunting procedure is selected based on the patient’s condition and the source of the problem. For example, if a patient has ascites, a “calibrated” porto-caval shunt with part of the patient’s own vein is selected. For a patient with bleeding esophageal varices, a spleno-renal shunt is an excellent choice in elective settings; however, this shunt is contraindicated in bleeding emergencies. Understanding each patient’s specific situation is paramount in order to have a successful outcome.
Surgical shunts are extremely challenging because of the dramatically increased risk of bleeding with portal hypertension. Meticulous technical skills and knowledge of anatomy are necessary. Although surgical shunts are not used as often these days, we still perform these surgeries several times a year with good results.
If you have been diagnosed with portal hypertension, ascites, and/or esophageal varices, please contact Dr. Dmitry Alden and we will be able to help you select the right treatment based on your needs.
In addition to an office-based consultation, the NYC liver cancer & pancreatic cancer surgeon offers remote consultations to patients and medical professionals anywhere in the world. Please call our office for details.
Please note: Dr. Alden accepts insurance if he participates with your plan. Additionally, if Dr. Alden does not participate with your insurance plan, Dr. Alden’s office is frequently able to obtain pre-authorization from your insurance plan based on the uniqueness of his specialty. We will contact your insurance company to understand your benefits and additionally submit them for you. You will enjoy the luxury and benefit of academic medicine in a top rated concierge environment without the hassle of long hospital waiting room times and paperwork. Most policies reimburse patients for most of the cost of surgery. Our surgical coordinator will help you with a quote.
For more information on Portal Hypertention (Ascites, Esophageal Varices) Surgery or for a consultation with the best in class liver surgeon, please feel free to contact the NYC Liver, Pancreatic & Bile Duct Oncological Surgeon, Dmitri Alden, MD, FACS, today by phoning his New York office (212) 434-6216 or contacting us online.